Patient experiences of exacerbations in a real world setting: Global results from the Hidden Depths survey

Background: There are many clinical trials in which COPD exacerbations have been studied but less is known about the real life patient impact. Aim: To establish patient reported exacerbation frequency in a real world, global setting & investigate their emotional & physical impact. Method: A cross-sectional online survey of clinician diagnosed COPD patients from 14 countries conducted from 09/07 to 02/09 2010. Patients were recruited from opt-in research panels with >18,000,000 members. 255,710 people were invited to participate in the survey. 75,233 respondents were screened. Patients self-classified their COPD severity using the MRC dyspnoea scale. Results: 2,000 patients were interviewed (1231=MRC1&2 (M1-2) & 769=MRC3,4&5 (M3-5) & mean age of 53 years). 73% of M1-2 & 64% of M3-5 patients thought they controlled their COPD but reported 10 (M1-2) to 18 (M3-5) days in a 30 day month as negatively affected by COPD. Regardless of severity or treatment, the percentage of patients reporting exacerbations in the preceding year was high: 27% of M1-2 & 52% of M3-5 patients who experienced exacerbations reported a hospitalisation & 6% of these M3-5 patients reported never recovering to their prior state of health. Patients also reported significant effects on their personal lives with 71%, 58% & 77% respectively reporting an effect on their sex life, relationship with partner & ability to socialise freely. Conclusions: Despite recruiting a relatively young patient cohort on treatment, exacerbation frequency in the real world setting is high & the burden on patients is substantial.